Size Dictates in the Treatment of Papillary Thyroid Carcinoma

Abstract

Background & objectives: Papillary thyroid cancer (PTC) is the most prevalent histologic subtype of thyroid cancer accounting for more than 80% of all cases and size of the thyroid nodule in PTC is considered the determinant factor in thyroid surgery i.e. hemithyroidectomy or total thyroidectomy. A single size threshold of 4 cm maximized prognostic discrimination with tumors size >4 cm associated with a five times higher risk of recurrence than those ≤4 cm. The present study aimed to determine an effective treatment strategy for patients with small unilateral papillary thyroid carcinoma in a low risk group below tumor size ≤4 cm. Material and methods: A prospective study was carried out on 700 patients who were diagnosed as papillary thyroid carcinoma by preoperative FNAC or postoperative histopathology. The age of the patients’ was ranged between 15 to 45 years. The criteria were: tumor ≤4 cm, unilateral involvement, cytological non-aggressive subtype, absence of lymph node involvement and extra thyroidal extension on ultrasonography and absence of clinical distant metastases. The study was conducted in tertiary care hospital in Bangladesh from 2004 to 2019. Results: 700 patients were included in the study, 667 patients (95.3%) did not show any recurrence of disease. 33 patients (4.7 %) came with locoregional recurrence of disease in clinical and USG findings without any distant metastasis. Maximum patients were between the ages 31-40 year followed by 21-30 year. Female was outnumber male in the ratio 2.5:1 Conclusion: This study can lead to a result that hemi thyroidectomy is now-a-days a better surgical option for PTC even up to tumor size of ≤4 cm.